Reach-B

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REACH-B: Advice – Online Form
Please provide patient case information using the form below and a specialist will be in touch to provide support within 48 hours. You are welcome to use the form multiple times for different cases or questions. You will receive a PDF of the completed form to your email upon submission. Patient data is de-identified and collected for the REACH-B Study.
* Indicates required field

Please ensure that no identifying patient information is included in your submission and that patient confidentiality is maintained.
Date of request*
Clinician information
Clinician name*
Clinician phone number (mobile)*
Clinician email address*

Please use a personal email address NOT a general clinic email
Would you prefer to be contacted via:
- Email
- Phone
Please note: if we are unable to contact you by phone we will send an email response
Clinic Name
Clinician phone number (clinic)
Clinician postcode*
Would you like to be sent information on ASHM hepatitis B education and training?
- Yes
- No
Patient/case details
Patient Initials*
Date of birth*
Gender*
- Male
- Female
- Non-Binary
- Transgender Male (assigned female at birth)
- Transgender Female (assigned male at birth)
- Patient prefers not to disclose
- Differently described, please specify
Interpretation of blood results and normal ranges can change depending on a person’s gender/sex.
Differently described, please specify
Country of birth*
Is there any other background about this patient that would be important to be aware of? (For example: Cultural Background, Medicare eligibility, etc.)
Serology and clinical information
Please advise on results of most recent tests
HBsAg*
- Positive
- Negative
- Not done
anti-HBc*
- Positive
- Negative
- Not done
anti-HBs
- Positive
- Negative
- Not done
HbeAg*
- Positive
- Negative
- Not done
HBV DNA (viral load)*
Please enter a number
ALT (U/L)*
ALT Upper limit of normal*
AST (U/L)*
AST Upper limit of normal (for the pathology service)*
Please enter a number less than or equal to 99.
Platelets (10^9/L)*
* Please double check number entered.
APRI
Does the patient have cirrhosis?*
- Yes
- No
- Unknown
Elastography (e.g Fibroscan) Assessment score (if available)
i.e., Fibroscan or similar
Liver ultrasound (if available)
Were these tests done in the last 12 months?*
- Yes
- No
If not, please consider ordering updated serology or imaging
What previous HBV regimens (select all that apply if patient had multiple HBV treatments)*
- None
- Pegylated Inteferon
- Lamivudine
- Adefovir
- Tenofovir disoproxilfumerate (TDF)
- Tenofovir alafenamide (TAF)
- Entecavir
- Emticitabine (FTC)
- Descovy
- Truvada
- Other
Other treatment regimen, specify*
Current HBV regimen (select all that apply)*
- None
- Pegylated Inteferon
- Lamivudine
- Adefovir
- Tenofovir disoproxilfumerate (TDF)
- Tenofovir alafenamide (TAF)
- Entecavir
- Emticitabine (FTC)
- Descovy
- Truvada
- Other
Other current treatment regimen, specify*
Does your enquiry relate to?*
- Treatment initiation support
- Ongoing monitoring support
- Isolated anti-HBc positive
- Suspected HCC and/or other HCC enquiries
- What tests to order
- Pregnancy and hepatitis B
- Cancer and hepatitis B
- Stopping hepatitis B medication
- Drug interactions
- Immunosuppression in the context of previous infection and core antibody positive
- Other
Please provide details of this case*
If available, please consider including information on/results: Co-infection (Hepatitis C, HIV, Hepatitis D) and current management of this; Any assessment of liver disease: APRI if available, Fibroscan and/or Liver ultrasound; If relevant: anti-HBc IgM = positive/negative; All other relevant context and information.
Is there any further clinical information that would be relevant?
Please consider including information on: Other relevant blood test results including FBE, LFT & INR; Patients’ BMI; Any other comorbidities Any relevant family history (especially HCC); List of current medications
What advice are you seeking?
What phase of infection is this patient in?*
- HBeAg-positive chronic infection (Immune tolerance)
- HBeAg-positive chronic hepatitis (Immune clearance)
- HBeAg-negative chronic infection (Immune control)
- HBeAg-negative chronic hepatitis (Immune escape)
- Unsure
Would you suggest that this patient should be commenced on treatment?*
- Yes
- No
- Unsure
If yes, what medication would you wish to prescribe?*
- Tenofovir
- Entecavir
- Unsure
Is there anything further you would like to add about your treatment plan for this patient?
What is your plan for ongoing monitoring?*
Does this patient require HCC surveillance?*
- Yes
- No
- Unsure
What will this include?
- Liver ultrasound
- AFP (blood test)
- Other
- Not sure
Multiple options available
How often would you do HCC surveillance?
- 3 monthly
- 6 monthly
- Yearly
- Not sure
Is there anything else you would like to add?
Additional files
Please attach any supporting information that might be useful such as pathology results, imaging, case notes etc. Please note: these must be de-identified and not contain any identifiable patient information.
Upload a file
Accepted file types: jpg, png, pdf, Max. file size: 5 MB.

REACH-B

REACH-B: Advice – Online Form

Clinician information

Patient/case details

Serology and clinical information

Additional files